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Smeekes OS, de Boer TR, van der Mei RD, Buurman BM, Willems HC. Differentiating Between Home Care Types to Identify Older Adults at Risk of Adverse Health Outcomes in the Community. J Am Med Dir Assoc 2024; 25:105257. [PMID: 39276795 DOI: 10.1016/j.jamda.2024.105257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 08/05/2024] [Accepted: 08/06/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES Acute hospitalization, recurrent admissions, institutionalization, and death are important adverse health outcomes. Older adults receiving home care are especially at risk of these outcomes, yet it remains unclear if this risk differs between older adults receiving different types of home care and older adults not receiving home care. DESIGN Retrospective cohort study using national claims data from 2019. SETTING AND PARTICIPANTS Community-dwelling Dutch individuals aged ≥ 65 years (N = 3,174,953). METHODS Participants were categorized: no home care, household help, personal care, household help combined with personal care, or nursing home care at home. The primary outcomes were the number of people experiencing acute hospitalization, recurrent admissions, institutionalization, or death. Logistic regression models were applied. RESULTS In total, 2,758,093 adults were included in the no home care group, 131,260 in the household help group, 154,462 in the personal care group, 96,526 in the household help combined with personal care group, and 34,612 in the nursing home care at home group. The risk of adverse outcomes differed between home care groups, with all showing higher odds compared with the no home care group. Individuals receiving household help combined with personal care had the highest odds for acute hospitalization [odds ratio (OR), 2.60; 95% CI, 2.55-2.64] and recurrent admissions (OR, 2.60; 95% CI, 2.55-2.65), while those receiving nursing home care at home had the highest odds for death (OR, 7.59; 95% CI, 7.35-7.85) and institutionalization (OR, 63.22; 95% CI, 60.94-65.58). CONCLUSIONS AND IMPLICATIONS Differentiating between the type of home care older adults receive identifies subpopulations with different risks for adverse health outcomes compared with older adults not receiving home care. Older adults receiving personal care (nurse based) are at high risk for these outcomes and represent a substantial population with prevention potential. Future research should focus on developing effective interventions for this group.
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Affiliation(s)
- Oscar S Smeekes
- Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands.
| | - Tim R de Boer
- Centrum Wiskunde & Informatica, Amsterdam, The Netherlands
| | | | - Bianca M Buurman
- Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Medicine for Older People, Amsterdam, The Netherlands
| | - Hanna C Willems
- Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
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Smeekes OS, De Boer TR, Van Der Mei RD, Buurman BM, Willems HC. Receiving home care forms and the risk for emergency department visits in community-dwelling Dutch older adults, a retrospective cohort study using national data. BMC Public Health 2024; 24:1792. [PMID: 38970060 PMCID: PMC11225288 DOI: 10.1186/s12889-024-19305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/28/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Older adults receiving home care have a higher risk of visiting the emergency department (ED) than community-dwelling older adults not receiving home care. This may result from a higher incidence of comorbidities and reduced functional autonomy in home care recipients. Since people receive different types of home care because of their different comorbidities and autonomy profiles, it is possible that distinguishing between the form of home care can help identify subpopulations with different risks for ED visits and help develop targeted interventions. This study aimed to compare the risk of visiting the ED in older adults receiving different forms of home care with those living at home without receiving home care in a national cohort in one year. METHODS A retrospective cohort study using claims data collected in 2019 on the Dutch population aged ≥ 65 years (N = 3,314,440) was conducted. Participants were classified as follows: no claimed home care (NO), household help (HH), personal care (PC), HH + PC, and nursing home care at home (NHH). The primary outcome was the number of individuals that visited the ED. Secondary outcomes were the number of individuals whose home care changed, who were institutionalized, or who died. Exploratory logistic regression was applied. RESULTS There were 2,758,093 adults in the NO group, 131,260 in the HH group, 154,462 in the PC group, 96,526 in the HH + PC group, and 34,612 in the NHH group. More ED visits were observed in the home care groups than in the NO group, and this risk increased to more than two-fold for the PC groups. There was a significant change to a more intensive form of home care, institutionalization, or death in all groups. CONCLUSIONS Distinguishing between the form of home care older adults receive identifies subpopulations with different risks for ED visits compared with community-dwelling older adults not receiving home care on a population level. Home care transitions are frequent and mostly involve more intensive care or death. Although older adults not receiving home care have a lower risk of ED visits, they contribute most to the absolute volume of ED visits.
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Affiliation(s)
- Oscar S Smeekes
- Internal Medicine, section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
| | - Tim R De Boer
- Centrum Wiskunde & Informatica, Science Park 123, Amsterdam, the Netherlands
| | | | - Bianca M Buurman
- Internal Medicine, section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medicine for Older People, Amsterdam Public Health Research Institute, De Boelelaan 117, Amsterdam, the Netherlands
| | - Hanna C Willems
- Internal Medicine, section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
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Wahyudi ER, Ronoatmodjo S, Setiati S, Besral, Soejono CH, Kuswardhani T, Fitriana I, Marsigit J, Putri SA, Harmany GRT. The risk of rehospitalization within 30 days of discharge in older adults with malnutrition: A meta-analysis. Arch Gerontol Geriatr 2024; 118:105306. [PMID: 38071901 DOI: 10.1016/j.archger.2023.105306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Malnutrition is a global health problem associated with higher rehospitalization risk, subsequently increasing the risks of adverse complications, and mortality in older individuals. Nevertheless, studies investigating this are still scarce, and even fewer reviewed and aggregated. A number of studies have recently assessed the correlation of malnourishment with rehospitalization among older adults. OBJECTIVE/AIM This systematic review and meta-analysis aimed to elaborate the correlation between malnutrition and 30-day rehospitalization in older adults. METHODS Systematic review was conducted on literatures from Cochrane, ScienceDirect, SpringerLink, Oxford Academic, and MEDLINE according to PRISMA Guideline, investigating the correlation of malnutrition in older adults with rehospitalization, using Malnutrition, Older Adults, and Rehospitalization as keywords. Meta-analysis was done using RevMan, with random-effect analysis model. P values of ≤0.05 were considered statistically significant with results reported as risk ratios (RR), mean differences (MD), 95 % confidence intervals (CI) and I2 statistics. RESULTS Seven literatures were analysed, consisting of 19,340 patients aged 65 or older undergoing hospitalization. Subjects were assessed with screening tools to identify malnutrition. Malnourished subjects are compared to others with normal nutrition; in cohort studies with follow-up period ranging from 3 to 16 months. Malnutrition significantly increased the risks of rehospitalization within 30 days (RR 1.73 [95 % CI 1.10-2.72], p = 0.02, I2 = 56 %), overall rehospitalization at all times (RR 1.33 [95 % CI 1.16-1.52], p < 0.0001, I2 = 75 %), and overall mortality (RR 2.66 [95 % CI 1.09-6.50], p = 0.03, I2 = 94 %). CONCLUSION Malnutrition exhibited significant consequences in older patients regarding the rate of rehospitalization and mortality based on this meta-analysis. Further research is highly encouraged to verify this finding.
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Affiliation(s)
- Edy Rizal Wahyudi
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia; Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Sudarto Ronoatmodjo
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia
| | - Siti Setiati
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia; Center of Clinical Epidemiology and Evidence-Based Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia
| | - Besral
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia
| | - Czeresna Heriawan Soejono
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia; Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Tuty Kuswardhani
- Geriatric Division, KSM Department of Internal Medicine, Prof. Ngoerah Hospital, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
| | - Ika Fitriana
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Jessica Marsigit
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Stella Andriana Putri
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia
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Fritsche G, Schoonenboom N, Van der Kroon H, Douma CE, Van der Dussen J, Verlaan M, Cloosterman B, Heems M, Nepal A, Toor EJ, de Rooij A, van Stralen KJ, Lucke JA. The effect of regional transmural agreements on the information transfer of frail older patients. BMC Geriatr 2023; 23:787. [PMID: 38030983 PMCID: PMC10688100 DOI: 10.1186/s12877-023-04519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/25/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Frail older patients are at risk for many complications when admitted to the hospital. Multidisciplinary regional transmural agreements (RTA) in which guidelines were set concerning the information transfer of frail older patients might improve outcomes. We aim to investigate the effect of implementation of the RTA on the completeness of the information transfer of frail older patients when admitted to and discharged from the hospital. METHODS This is a retrospective cohort study in which we collected data from 400 randomly selected hospitalized frail older patients (70+) before the implementation of the RTA, January through March 2021, and after, October through December 2021. The cohort was split up into four groups, which determined what correspondence would be checked (referral letter by General Practitioner (GP) and three groups of 'hospital letters': ED letter upon admittance, clinical discharge letter to the elderly care physician and clinical discharge letter to the GP. We assessed for mention of frailty, a medication list and mention of resuscitation orders. RESULTS In the period before implementation the mean age of patients was 82.6 years (SD 7.4) and 101 were female (50.5%), after implementation mean age was 82.3 (SD 6.9) and 112 were female (56.0%). Frailty was mentioned in hospital letters in 12.7% before and 15.3% after implementation (p = 0.09). More GP referral letters were present after implementation (32.0% vs. 54.0%, p = 0.03), however frailty was mentioned only in 12.5% before and 7.4% after (p = 0.58). There was a good handover of medication lists from the hospital (89.3% before, 94% after, p = 0.20) and even better from the GP (93.8% before, 100% after, p = 0.19). Resuscitation orders were mentioned in 59.3% of letters from the hospital before implementation and 57.3% after (p = 0.77), which is higher than in the referral letters (18.8% before and 22.2% after (p = 0.91). DISCUSSION The implementation of RTA improved the number of GP referral letters present; however, it did not lead to other significant improvements in communication between the hospital and the GP's. Frailty and resuscitation orders are still frequently not mentioned in the reports. After a successful reimplementation, the improvements of outcomes could be investigated.
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Affiliation(s)
- G Fritsche
- Department of Emergency Medicine, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, 2035 RC, The Netherlands
| | - N Schoonenboom
- Department of Neurology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - H Van der Kroon
- Department of Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - C E Douma
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Mne Verlaan
- General Practitioner, Haarlem, The Netherlands
| | | | - M Heems
- Elderly Care Physician, Amstelring, Hoofddorp, The Netherlands
| | - A Nepal
- Elderly Care Physician, Zorgbalans, Haarlem, The Netherlands
| | - E J Toor
- Transmural Coordinating Centre, Spaarne Gasthuis, Haarlem, The Netherlands
| | - A de Rooij
- Transmural Coordinating Centre, Spaarne Gasthuis, Haarlem, The Netherlands
| | - K J van Stralen
- Spaarne Gasthuis Academy, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - J A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, 2035 RC, The Netherlands.
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Pijls N, Joosten H, Theunissen M, van Leendert J, Courtens A, Magdelijns F, van den Beuken-van Everdingen M. Bedside palliative care and geriatric consultations: adherence rate in hospitalised patients. BMJ Support Palliat Care 2023:spcare-2023-004453. [PMID: 37679026 DOI: 10.1136/spcare-2023-004453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES This study examined the adherence rate of recommendations of a palliative consultation team (PCT) and a geriatric consultation team (GCT). Secondary aims were to investigate which factors and/or recommendation characteristics influence adherence rates. METHODS This retrospective cohort study was performed in the Maastricht University Medical Center+ in the Netherlands and included hospitalised patients who received a consultation by the PCT or the GCT. Baseline data on consultations were collected for the total population and for the GCT and PCT separately. The adherence rate of the recommendations was evaluated by checking evidence of implementation. The nature of recommendations given (solicited or unsolicited) was documented per domain (somatic, psychological/cognitive, social, spiritual, functional, and existential). The association with adherence was evaluated for solicited and unsolicited recommendations separately. Exploration of potentially associated factors was performed using OpenEpi. RESULTS Overall, 507 consultations of individual patients were performed (n=131) by the GCT and (n=376) by the PCT. Most recommendations given were solicited (865/1201=72%). Over 80% of both solicited and unsolicited recommendations were implemented in the majority of domains. No potentially modifiable factors associated with the adherence of the advices were found. CONCLUSIONS The overall adherence rate of the GCT and PCT consultations was high. In addition, in certain domains, many recommendations were unsolicited. However, also the majority of these recommendations were implemented.
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Affiliation(s)
- Noor Pijls
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Hanneke Joosten
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Maurice Theunissen
- Center of Expertise for Palliative Care, MUMC+, Maastricht, The Netherlands
| | - Jannic van Leendert
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
| | - Annemie Courtens
- Center of Expertise for Palliative Care, MUMC+, Maastricht, The Netherlands
| | - Fabienne Magdelijns
- Division of General Medicine, Department of Internal Medicine, Section of Geriatric Medicine, MUMC+, Maastricht, The Netherlands
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Jukic Peladic N, Orlandoni P. Development of Quality Indicators for Geriatric Home Enteral Nutrition (HEN) Services. Nutrients 2023; 15:3119. [PMID: 37513537 PMCID: PMC10384251 DOI: 10.3390/nu15143119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The evidence on the safety, efficacy and patient centeredness of Home Enteral Nutrition (HEN) services is scarce. In 2015, we carried out a search of the literature to identify specific indicators for HEN services as tools to be used to assess the quality of INRCA HEN services. No specific indicators for HEN services were found. Through a subsequent search of the literature, we have identified the appropriate methodology to define quality indicators and developed eight (8) specific indicators to track the quality of our HEN service for geriatric patients. Following Donabiedan's classification, we have defined two structure indicators, two process indicators and four outcome indicators that are presented in this manuscript. Though they may be used to make a comparison of HEN services for geriatric patients and to monitor the quality of therapy provided at patients' homes, the definition of quality system indicators for HEN services requires the additional joint efforts of experts in the field of nutrition and the scientific community for their validation.
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Affiliation(s)
- Nikolina Jukic Peladic
- Vivisol Srl., Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
| | - Paolo Orlandoni
- Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
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Bernabeu-Wittel M, Para O, Voicehovska J, Gómez-Huelgas R, Václavík J, Battegay E, Holecki M, van Munster BC. Competences of internal medicine specialists for the management of patients with multimorbidity. EFIM multimorbidity working group position paper. Eur J Intern Med 2023; 109:97-106. [PMID: 36653235 DOI: 10.1016/j.ejim.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
Patients with multimorbidity increasingly impact healthcare systems, both in primary care and in hospitals. This is particularly true in Internal Medicine. This population associates with higher mortality rates, polypharmacy, hospital readmissions, post-discharge syndrome, anxiety, depression, accelerated age-related functional decline, and development of geriatric syndromes, amongst others. Internists and Hospitalists, in one of their roles as Generalists, are increasingly asked to attend to these patients, both in their own Departments as well as in surgical areas. The management of polypathology and multimorbidity, however, is often complex, and requires specific clinical skills and corresponding experience. In addition, patients' needs, health-care environment, and routines have changed, so emerging and re-emerging specific competences and approaches are required to offer the best coordinated, continuous, and comprehensive integrated care to these populations, to achieve optimal health outcomes and satisfaction of patients, their relatives, and staff. This position paper proposes a set of emerging and re-emerging competences for internal medicine specialists, which are needed to optimally address multimorbidity now and in the future.
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Affiliation(s)
- M Bernabeu-Wittel
- Department of Medicine, Internal Medicine Department. Hospital Universitario Virgen del Rocío, University of Sevilla, Spain
| | - O Para
- Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - J Voicehovska
- Internal Diseases Department, Nephrology and Renal replacement therapy clinics, Riga Stradins University, Riga East University hospital, Riga, Latvia
| | - R Gómez-Huelgas
- Internal Medicine Department. Department of Medicine, Hospital Universitario Regional de Málaga, University of Málaga, Spain
| | - J Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava and Ostrava University Faculty of Medicine, Ostrava, Czech Republic
| | - E Battegay
- International Center for Multimorbidity and Complexity (ICMC), University of Zurich, Zurich, University Hospital Basel (Department of Psychosomatic Medicine) and Merian Iselin Klinik Basel. Switzerland
| | - M Holecki
- Department of Internal, Autoimmune and Metabolic Diseases. Medical University of Silesia, Katowice. Poland
| | - B C van Munster
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Cilla F, Sabione I, D’Amelio P. Risk Factors for Early Hospital Readmission in Geriatric Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1674. [PMID: 36767038 PMCID: PMC9914102 DOI: 10.3390/ijerph20031674] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The number of older patients is constantly growing, and early hospital readmissions in this population represent a major problem from a health, social and economic point of view. Furthermore, the early readmission rate is often used as an indicator of the quality of care. We performed a systematic review of the literature to better understand the risk factors of early readmission (30 and 90 days) in the geriatric population and to update the existing evidence on this subject. The search was carried out on the MEDLINE, EMBASE and PsycINFO databases. Three independent reviewers assessed the potential inclusion of the studies, and then each study was independently assessed by two reviewers using Joanna Briggs Institute critical appraisal tools; any discrepancies were resolved by the third reviewer. Studies that included inpatients in surgical wards were excluded. Twenty-nine studies were included in the review. Risk factors of early readmission can be classified into socio-economic factors, factors relating to the patient's health characteristics, factors related to the use of the healthcare system and clinical factors. Among these risk factors, those linked to patient frailty play an important role, in particular malnutrition, reduced mobility, risk of falls, fatigue and functional dependence. The early identification of patients at higher risk of early readmission may allow for targeted interventions in view of discharge.
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Martínez-Velilla N, Buurman BM. Editorial: Towards a Real Personalized Geriatric Medicine: The Example of the Prevention of Hospital-Acquired Disability. J Nutr Health Aging 2023; 27:411-412. [PMID: 37357323 DOI: 10.1007/s12603-023-1936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Affiliation(s)
- N Martínez-Velilla
- N. Martínez-Velilla, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain,
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Steinman MA, Jing B, Shah SJ, Rizzo A, Lee SJ, Covinsky KE, Ritchie CS, Boscardin WJ. Development and validation of novel multimorbidity indices for older adults. J Am Geriatr Soc 2023; 71:121-135. [PMID: 36282202 PMCID: PMC9870862 DOI: 10.1111/jgs.18052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes. METHODS Health conditions were assessed using Medicare inpatient and outpatient claims from subjects age 67 and older in the Health and Retirement Study. Separate indices were developed for ADL decline, IADL decline, hospitalization, and death, each over 2 years of follow-up. We validated these indices using data from Medicare claims linked to the National Health and Aging Trends Study. RESULTS The development cohort included 5012 subjects with median age 76 years; 58% were female. Claims-based markers of disease severity and disease-disease interactions yielded minimal gains in predictive power and were not included in the final indices. In the validation cohort, after adjusting for age and sex, c-statistics for the new multimorbidity indices were 0.72 for ADL decline, 0.69 for IADL decline, 0.72 for hospitalization, and 0.77 for death. These c-statistics were 0.02-0.03 higher than c-statistics from Charlson and Elixhauser indices for predicting ADL decline, IADL decline, and hospitalization, and <0.01 higher for death (p < 0.05 for each outcome except death), and were similar to those from the CMS-HCC model. On decision curve analysis, the new indices provided minimal benefit compared with legacy approaches. C-statistics for both new and legacy indices varied substantially across derivation and validation cohorts. CONCLUSIONS A new series of claims-based multimorbidity measures were modestly better at predicting hospitalization and functional decline than several legacy indices, and no better at predicting death. There may be limited opportunity in claims data to measure multimorbidity better than older methods.
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Affiliation(s)
- Michael A. Steinman
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Bocheng Jing
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Sachin J. Shah
- Division of Hospital Medicine, UCSF, San Francisco, California, USA
| | - Anael Rizzo
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- David Geffen School of Medicine at UCLA, San Francisco, California, USA
| | - Sei J. Lee
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Kenneth E. Covinsky
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and the Mongan Institute Center for Aging and Serious Illness, Boston, MA, USA
| | - W. John Boscardin
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
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Amiri Gooshki E, Mangolian Shahrbabaki P, Asadi N, Salmani M. Psychological consequences and the related factors among COVID-19 survivors in southeastern Iran. Health Sci Rep 2022; 5:e755. [PMID: 35957974 PMCID: PMC9364432 DOI: 10.1002/hsr2.755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Coronavirus disease-2019 (COVID-19) is a new viral disease that has spread rapidly worldwide since December 2019 and there is no effective treatment for it. The current study aimed to investigate the psychological consequences and related factors among COVID-19 survivors. Methods This descriptive analytical study was conducted on 152 patients with COVID-19 referred to referral hospitals in southeastern Iran in 2020. Data collection tools were three questionnaires of demographic and background information, Depression Anxiety stress Scale (DASS-21) and Impact of Events Scale-Revised (IESR). Descriptive and inferential statistics and SPSS25 were used to analyze the data. Results The mean age of patients was 39.52 ± 13.16 years. The patients were mostly female (63.8%). Seventy-three percent of the patients had severe posttraumatic stress disorder, 26.3% had moderate depression and 26.3% had severe anxiety. The mean scores of posttraumatic stress, depression, and anxiety among patients with COVID-19 were 41.59 ± 17.28, 12.13 ± 9.16, and 12.45 ± 10.71, respectively. Intensive care unit (ICU) admission, divorce, illiteracy, and retirement were all associated with higher psychological load among patients. Discussion and Conclusion The results showed that patients with COVID-19 had different levels of anxiety, depression, and posttraumatic stress. These results may direct the attention of the medical staff to the mental health of COVID-19 patients, necessitating timely psychological care and intervention during an epidemic.
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Affiliation(s)
- Esmat Amiri Gooshki
- Nursing Research Center, Department of Critical Care NursingKerman University of Medical SciencesKermanIran
| | | | - Neda Asadi
- Nursing Research Center, Department of Critical Care NursingKerman University of Medical SciencesKermanIran
| | - Mahin Salmani
- Department of Mathematics and StatisticsUniversity of New BrunswickFrederictonCanada
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12
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Naseri C, Haines TP, Morris ME, McPhail SM, Etherton-Beer C, Shorr R, Flicker L, Waldron N, Bulsara M, Hill AM. Factors Affecting Engagement of Older Adults in Exercise Following Hospitalization. J Geriatr Phys Ther 2022; 45:197-206. [PMID: 35905031 DOI: 10.1519/jpt.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Exercise interventions can improve physical recovery and reduce falls in older adults following hospitalization. The aim of the study was to identify factors associated with exercise engagement after hospital discharge. METHODS This study was a secondary analysis of data collected as part of a randomized controlled trial. Participants were 60 years and older, discharged from 3 rehabilitation hospitals in Australia, and followed for 6 months after discharge. The primary outcome was level of engagement in exercise after discharge, measured using setting, type, frequency, and time. A secondary outcome was self-efficacy for exercise at 6-month follow-up. Data were gathered at baseline in hospital and at 6 months after discharge by telephone using structured surveys. Associations between exercise and participant characteristics were evaluated using logistic regression models. RESULTS AND DISCUSSION Participants' (n = 292) mean age was 78 (SD 8) years and 63% were female. There were 146 (50%) who exercised after hospitalization for a median (interquartile range) time of 60 (60-75) minutes per week. Characteristics that were significantly associated with post-discharge engagement in exercise were having higher levels of functional ability at discharge (adjusted odds ratio [AOR] 1.2, 95% CI 1.0, 1.4), living with a partner (AOR 2.9, 95% CI 1.7, 4.9), and engagement in exercise prior to hospital admission (AOR 1.7, 95% CI 1.0, 2.8). The mean self-efficacy for exercise score at 6 months post-discharge was 58.5/90 (SD 24.5). Characteristics that were significantly predictive of a higher mean self-efficacy score at 6 months after hospitalization were having a college or university education (adjusted β-coefficient [Adj β] 11.5, 95% CI 3.8, 19.0), exercise prior to hospital admission (Adj β 12.3, 95% CI 5.1, 19.5), living with a partner at discharge (Adj β 14.5, 95% CI 7.1, 21.9), and higher functional ability at discharge (Adj β 4.0, 95% CI 1.9, 6.1). CONCLUSION Older adults have low levels of engagement in exercise that might impact their recovery after hospitalization. During exercise prescription, clinicians should prioritize older adults who live alone, who have lower functional ability, and no previous habit of exercising.
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Affiliation(s)
- Chiara Naseri
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.,WA Centre for Health and Ageing, University of Western Australia, Perth, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
| | - Meg E Morris
- Healthscope ARCH, Victorian Rehabilitation Centre, Glen Waverley, Australia.,College of Healthcare Sciences, James Cook University, Douglas, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, University of Western Australia, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, Florida.,College of Medicine, University of Florida, Gainesville
| | - Leon Flicker
- WA Centre for Health and Ageing, University of Western Australia, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Nicolas Waldron
- Department of Geriatric Rehabilitation, Armadale Health Service, Mount Nasura, and Department of Health Western Australia, Perth, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Anne-Marie Hill
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.,WA Centre for Health and Ageing, University of Western Australia, Perth, Australia
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13
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Post-Hospital Availability of Instrumental Support May Influence Patients' Readiness for Discharge. Prof Case Manag 2022; 27:194-202. [PMID: 35617535 DOI: 10.1097/ncm.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY Evaluate the relationship between unplanned acute care utilization after discharge from an index hospital admission and registered nurse and patient perceptions of available instrumental support the patient would have after discharge. PRIMARY PRACTICE SETTING Three hospitals in a large regional hospital system in the southeastern United States. METHODOLOGY AND SAMPLE Retrospective, secondary quantitative analysis of 13,361 patient records (mean age 58.4 years; 51% female) from index hospitalizations evaluating patient and nurse responses to 2 questions that specifically address instrumental support on both the patient and nurse versions of the Readiness for Hospital Discharge Survey (RHDS) and subsequent unexpected care received (emergency department [ED] visit, observation stay, hospital readmission) in the acute care setting within 60 days of discharge. Logistic regression was used to evaluate the relationship between RHDS scores and unplanned care received. RESULTS Patients who required hospital-based acute care within 60 days after discharge had lower average RN-RHDS scores than those who did not require hospital-based acute care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Including a nursing assessment of potential postdischarge expected instrumental support may be helpful in identifying patients who are at a higher risk of experiencing postdischarge acute care utilization. Monitoring ED visits and observation stays in addition to readmissions will facilitate capturing significantly more points of care received after discharge and provide additional information regarding postdischarge care utilization.
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14
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Arieli M, Kizony R, Gil E, Agmon M. Many Paths to Recovery: Comparing Basic Function and Participation in High-Functioning Older Adults After Acute Hospitalization. J Appl Gerontol 2022; 41:1896-1904. [PMID: 35543173 DOI: 10.1177/07334648221089481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Function after acute hospitalization is mostly operationalized by Basic Activities of Daily Living (BADL), a limited concept that overshadows a wide range of instrumental, social, and recreational activities, otherwise referred to as participation. Participation is important for patients' health and quality of life after hospitalization. This study focuses on high-functioning older adults, examining functional recovery after hospitalization by comparing BADL assessment with assessment of participation at one and three months following discharge relative to pre-hospitalization. Quantitative data were collected from 72 participants divided into two age groups of hospitalized older adults (age 65-74, n = 38; age ≥75, n = 34), followed by home visits after 1 month and telephone interviews 3 months after discharge. Both groups experienced a significantly greater decline in participation, compared with BADL, which were mostly preserved. A comprehensive assessment of participation better captures functional changes in high-functioning older adults. Early identification of participation withdrawal is crucial for preventing disability.
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Affiliation(s)
- Maya Arieli
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel
| | - Rachel Kizony
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel.,Department of Occupational Therapy, Sheba Medical Center, Tel Hashomer, Israel
| | - Efrat Gil
- Geriatric Unit, Clalit Health Services, Haifa and West Galilee.,Faculty of Medicine, Technion, Haifa, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Israel
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15
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Welch C, Greig C, Lewis D, Majid Z, Masud T, Moorey H, Pinkney T, Stanley B, Jackson T. Trajectories of muscle quantity, quality and function measurements in hospitalized older adults. Geriatr Gerontol Int 2022; 22:311-318. [PMID: 35246911 PMCID: PMC9313889 DOI: 10.1111/ggi.14366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
AIM Acute sarcopenia is defined by the development of incident sarcopenia (low muscle quantity/quality and function) within 6 months of a stressor event. However, outcome measures for clinical trials have not been validated. This study aimed to characterize changes in muscle quantity, quality, strength, and physical function during and after hospitalization. METHODS Patients aged ≥70 years admitted for elective colorectal surgery, emergency abdominal surgery or acute infections were recruited from a single university hospital. Assessments were carried out at baseline, and within 7 ± 2 days and 13 ± 1 weeks postoperatively or post-admission. RESULTS A total of 79 participants (mean age 79 years, 39% female) were included. Physical function defined by the Patient-Reported Outcome Measures Information System T-score declined from baseline (42.3, 95% CI 40.2-44.3) to 7 days (36.6, 95% CI 34.5-38.8; P = 0.001), with improvement after 13 weeks (40.5, 95% CI 37.9-43.0). Changes in muscle quantity, quality and function measurements were overall heterogeneous, with few significant changes at the study population level. Change in rectus femoris echogenicity over 13 weeks correlated with changes in handgrip strength (r = 0.53; P < 0.001) and gait speed (r = 0.59; P = 0.003) over the same period. CONCLUSIONS Patient-Reported Outcome Measures Information System T-score provides a sensitive measure of change in physical function in hospitalized older patients. However, changes in muscle quantity, quality and function measurements were heterogeneous, and not significant at the study population level. Further research should assess for factors that might be predictive of changes within individuals to enable stratified interventions. Geriatr Gerontol Int 2022; 22: 311-318.
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Affiliation(s)
- Carly Welch
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Carolyn Greig
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- School of Sport, Exercise, and Rehabilitation SciencesUniversity of BirminghamBirminghamUK
- Birmingham Biomedical Research CenterUniversity of Birmingham and University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Danielle Lewis
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Zeinab Majid
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Tahir Masud
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Nottingham University Hospitals NHS TrustNottinghamUK
- University of NottinghamNottinghamUK
| | - Hannah Moorey
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Thomas Pinkney
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Academic Department of SurgeryUniversity of BirminghamBirminghamUK
| | - Benjamin Stanley
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Thomas Jackson
- Medical Research Council (MRC) – Versus Arthritis Center for Musculoskeletal Aging ResearchUniversity of Birmingham and University of NottinghamBirminghamUK
- Institute of Inflammation and Aging, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
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16
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Schultz BE, Corbett CF, Hughes RG. Instrumental support: A conceptual analysis. Nurs Forum 2022; 57:665-670. [PMID: 35133664 PMCID: PMC9544712 DOI: 10.1111/nuf.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/27/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
The aim of this paper was to use the Walker and Avant method of concept analysis to evaluate the concept of instrumental support in the context of hospital to home care transitions. Findings from this concept analysis suggest three defining attributes of instrumental support: informal support providers, tangible support, and unmet personal needs. Antecedents identified: a strong and supportive social network, an independently functioning adult, an illness resulting in hospitalization, a change in functional status, and the patient being discharged home from the hospital. Consequences of not having adequate instrumental support: unsuccessful recovery at home, increased risk for hospital readmission, decline in physical functioning, health complications, and increased risk of mortality. Empirical referents: patient's report of successful recovery, returning to an independent level of functioning, and the lack of hospital readmission or health complication. A model and a contrary case study were developed to provide examples of clinical cases related to instrumental support. Recommendations related to clinical practice include evaluating the availability/adequacy of instrumental support before hospital discharge and including the identified instrumental support person in the discharge planning process. There are proven benefits of having people within one's social network providing instrumental support during the home recovery period.
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Affiliation(s)
- Beth E. Schultz
- College of Pharmacy, Natural & Health Sciences Manchester University Fort Wayne Indiana USA
| | - Cynthia F. Corbett
- College of Nursing University of South Carolina Columbia South Carolina USA
| | - Ronda G. Hughes
- College of Nursing University of South Carolina Columbia South Carolina USA
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17
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Schultz BE, Corbett CF, Hughes RG, Bell N. Scoping review: Social support impacts hospital readmission rates. J Clin Nurs 2021; 31:2691-2705. [PMID: 34866259 DOI: 10.1111/jocn.16143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To review and synthesise the current literature on social support and hospital readmission rates. BACKGROUND Hospital readmission rates have not declined significantly since 2010 despite efforts to identify and implement strategies to reduce readmissions. After discharge, patients often report the need for help at home with personal care, medical care and/or transportation. Social factors can positively or negatively affect the transition from hospital to home and the extended recovery period experienced by patients. METHODS Published primary studies in peer-reviewed journals, written in English, assessing the adult medical/surgical population and discussing social support and hospital readmission rates were included. A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was completed for this scoping review. RESULTS The search resulted in 2919 articles. After removing duplicates and reviewing content for the inclusion and exclusion criteria, 23 articles were selected for review. Social support is provided by those within one's social circle. There are several types of social support and depending on the needs to the patient, the type of social required and provided is different. CONCLUSIONS The most common form of social support needed at home for people recovering after a hospitalisation was instrumental support, tangible care in the form of assistance with daily personal and medical care, and transportation. Patients who lacked adequate social support after discharge were at an increased risk of hospital readmission. RELEVANCE TO CLINICAL PRACTICE Identifying factors, such as social support, that may impact hospital readmission rates is important for quality hospital to home care transitions. Assessing patients' needs and available social support to meet those needs may be an essential part of the discharge planning process to decrease the risk of hospital readmission.
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Affiliation(s)
- Beth E Schultz
- University of South Carolina, Columbia, South Columbia, USA
| | | | - Ronda G Hughes
- University of South Carolina, Columbia, South Columbia, USA
| | - Nathaniel Bell
- University of South Carolina, Columbia, South Columbia, USA
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18
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Ticinesi A, Nouvenne A, Cerundolo N, Prati B, Parise A, Tana C, Rendo M, Guerra A, Meschi T. Accounting for frailty and multimorbidity when interpreting high-sensitivity troponin I tests in oldest old. J Am Geriatr Soc 2021; 70:549-559. [PMID: 34792185 PMCID: PMC9299120 DOI: 10.1111/jgs.17566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/17/2022]
Abstract
Background Older patients evaluated in Emergency Departments (ED) for suspect Myocardial Infarction (MI) frequently exhibit unspecific elevations of serum high‐sensitivity troponin I (hs‐TnI), making interpretation particularly challenging for emergency physicians. The aim of this longitudinal study was to identify the interaction of multimorbidity and frailty with hs‐TnI levels in older patients seeking emergency care. Methods A group of patients aged≥75 with suspected MI was enrolled in our acute geriatric ward immediately after ED visit. Multimorbidity and frailty were measured with Cumulative Illness Rating Scale (CIRS) and Clinical Frailty Scale (CFS), respectively. The association of hs‐TnI with MI (main endpoint) was assessed by calculation of the Area Under the Receiver‐Operating Characteristic Curve (AUROC), deriving population‐specific cut‐offs with Youden test. The factors associated with hs‐TnI categories, including MI, CFS and CIRS, were determined with stepwise multinomial logistic regression. The association of hs‐TnI with 3‐month mortality (secondary endpoint) was also investigated with stepwise logistic regression. Results Among 268 participants (147 F, median age 85, IQR 80–89), hs‐TnI elevation was found in 191 cases (71%, median 23 ng/L, IQR 11–65), but MI was present in only 12 cases (4.5%). hs‐TnI was significantly associated with MI (AUROC 0.751, 95% CI 0.580–0.922, p = 0.003), with an optimal cut‐off of 141 ng/L. hs‐TnI levels ≥141 ng/L were significantly associated with CFS (OR 1.58, 95% CI 1.15–2.18, p = 0.005), while levels <141 ng/L were associated with the cardiac subscore of CIRS (OR 1.36, 95% CI 1.07–1.71, p = 0.011). CFS, but not hs‐TnI levels, predicted 3‐month mortality. Conclusions In geriatric patients with suspected MI, frailty and cardiovascular multimorbidity should be carefully considered when interpreting emergency hs‐TnI testing.
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Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicoletta Cerundolo
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Parise
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Claudio Tana
- Internal Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital, Chieti, Italy
| | - Martina Rendo
- Primary Care Department, Parma District, Azienda Unità Sanitaria Locale di Parma, Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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19
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Vlake JH, Wesselius S, van Genderen ME, van Bommel J, Boxma-de Klerk B, Wils EJ. Psychological distress and health-related quality of life in patients after hospitalization during the COVID-19 pandemic: A single-center, observational study. PLoS One 2021; 16:e0255774. [PMID: 34379644 PMCID: PMC8357130 DOI: 10.1371/journal.pone.0255774] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to explore predictors for psychological distress and HRQoL, and to examine whether psychological distress was higher in COVID-19 confirmed patients, and in those treated in Intensive Care Units (ICUs). Methods In this single-center, observational cohort study, adult patients hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 PCR results and the necessity for ICU treatment. The primary outcome was psychological distress, expressed as symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression, up to three months post-discharge. Health-related quality of life (HRQoL) was the secondary outcome. Exploratory outcomes comprised predictors for psychological distress and HRQoL. Results 294 of 622 eligible patients participated in this study (median age 64 years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% and 20% probable anxiety, and 32% and 24% probabledepression at one and three months after hospital discharge, respectively. ICU patients reported less frequently probable depression, but no differences were found in PTSD, anxiety, or overall HRQoL. COVID-19 patients had a worse physical quality of life one month after discharge, and ICU patients reported a better mental quality of life three months after discharge. PTSD severity was predicted by time after discharge and being Caucasian. Severity of anxiety was predicted by time after discharge and being Caucasian. Depression severity was predicted by time after discharge and educational level. Conclusion COVID-19 suspected patients hospitalized during the pandemic frequently suffer from psychological distress and poor health-related quality of life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at least as affected as COVID-19 and ICU patients, underscoring that (post-)hospital pandemic care should not predominantly focus on COVID-19 infected patients.
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Affiliation(s)
- Johan Hendrik Vlake
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
- * E-mail:
| | - Sanne Wesselius
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Michel Egide van Genderen
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jasper van Bommel
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Bianca Boxma-de Klerk
- Department of Statistics and Education, Franciscus Academy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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20
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Jepma P, Verweij L, Tijssen A, Heymans MW, Flierman I, Latour CHM, Peters RJG, Scholte Op Reimer WJM, Buurman BM, Ter Riet G. The performance of the Dutch Safety Management System frailty tool to predict the risk of readmission or mortality in older hospitalised cardiac patients. BMC Geriatr 2021; 21:299. [PMID: 33964888 PMCID: PMC8105911 DOI: 10.1186/s12877-021-02243-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background Early identification of older cardiac patients at high risk of readmission or mortality facilitates targeted deployment of preventive interventions. In the Netherlands, the frailty tool of the Dutch Safety Management System (DSMS-tool) consists of (the risk of) delirium, falling, functional impairment, and malnutrition and is currently used in all older hospitalised patients. However, its predictive performance in older cardiac patients is unknown. Aim To estimate the performance of the DSMS-tool alone and combined with other predictors in predicting hospital readmission or mortality within 6 months in acutely hospitalised older cardiac patients. Methods An individual patient data meta-analysis was performed on 529 acutely hospitalised cardiac patients ≥70 years from four prospective cohorts. Missing values for predictor and outcome variables were multiply imputed. We explored discrimination and calibration of: (1) the DSMS-tool alone; (2) the four components of the DSMS-tool and adding easily obtainable clinical predictors; (3) the four components of the DSMS-tool and more difficult to obtain predictors. Predictors in model 2 and 3 were selected using backward selection using a threshold of p = 0.157. We used shrunk c-statistics, calibration plots, regression slopes and Hosmer-Lemeshow p-values (PHL) to describe predictive performance in terms of discrimination and calibration. Results The population mean age was 82 years, 52% were males and 51% were admitted for heart failure. DSMS-tool was positive in 45% for delirium, 41% for falling, 37% for functional impairments and 29% for malnutrition. The incidence of hospital readmission or mortality gradually increased from 37 to 60% with increasing DSMS scores. Overall, the DSMS-tool discriminated limited (c-statistic 0.61, 95% 0.56–0.66). The final model included the DSMS-tool, diagnosis at admission and Charlson Comorbidity Index and had a c-statistic of 0.69 (95% 0.63–0.73; PHL was 0.658). Discussion The DSMS-tool alone has limited capacity to accurately estimate the risk of readmission or mortality in hospitalised older cardiac patients. Adding disease-specific risk factor information to the DSMS-tool resulted in a moderately performing model. To optimise the early identification of older hospitalised cardiac patients at high risk, the combination of geriatric and disease-specific predictors should be further explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02243-5.
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Affiliation(s)
- Patricia Jepma
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands. .,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Lotte Verweij
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Arno Tijssen
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | - Isabelle Flierman
- Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Corine H M Latour
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.,Research Group Chronic Diseases, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Bianca M Buurman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Internal Medicine, section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gerben Ter Riet
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Deschodt M, Jeuris A, Van Grootven B, Van Waerebeek E, Gantois E, Flamaing J, Velghe A. Adherence to recommendations of inpatient geriatric consultation teams: a multicenter observational study. Eur Geriatr Med 2021; 12:175-184. [PMID: 32978747 PMCID: PMC7900061 DOI: 10.1007/s41999-020-00397-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Inpatient geriatric consultation teams (IGCTs) provide recommendations for the care of older patients hospitalized on non-geriatric wards based on comprehensive geriatric assessment. The lack of adherence to their recommendations hinders the potential impact of IGCTs. We evaluated the adherence to IGCT recommendations and determined which team and recommendation characteristics are related to higher adherence rates. METHODS Multicenter observational study in older adults aged ≥ 75 years admitted to an acute non-geriatric ward. Demographic and adherence data were collected for 30 consecutive patients. A cross-sectional survey mapped team and organizational characteristics of the participating IGCTs. RESULTS Analyses were conducted in 278 patients (51.4% male, mean age 82.5 years, and median length of stay 10 days). There was a median number of 3 recommendations (range 1-13) per patient. The overall adherence rate was 69.7%. Recommendations related to 'social status' (82.4%) and 'functional status/mobility' (73.3%) were best adhered to. Recommendations related to 'medication' (53.2%) and 'nutritional status' (59.1%) were least adhered to. Adherence rates increased if recommendations were given to allied health professionals (OR = 6.37, 95% CI = 1.15-35.35) or by more experienced IGCTs (OR = 1.34, 95% CI = 1.04-1.72) and decreased when more recommendations were given (OR = 0.51, 95% CI = 0.33-0.80). CONCLUSION Adherence rate to IGCT recommendations increased if given to allied health professionals or by more experienced IGCTs and when fewer recommendations were given. Study replication in an international multicenter study with a larger number of centers and evaluating the quality of the recommendations is suggested.
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Affiliation(s)
- Mieke Deschodt
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium.
- Department of Public Health, Nursing Science, University of Basel, Basel, Switzerland.
| | | | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | | | - Evie Gantois
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
- Geriatrics Department, University Hospitals Leuven, Leuven, Belgium
| | - Anja Velghe
- Geriatrics Department, University Hospitals Ghent, Ghent, Belgium
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22
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Optimizing Outcomes With Physical Therapy Treatment for IndividuALs Surviving an Intensive Care Units Admission for COVID-19 (OPTImAL)—A Protocol for a Single Center Prospective Study. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Di Bari M, Carreras G, Giordano A, Degli Esposti L, Buda S, Michelozzi P, Bernabei R, Marchionni N, Balzi D. Long-term Survival After Hospital Admission in Older Italians: Comparison Between Geriatrics and Internal Medicine Across Different Discharge Diagnoses and Risk Status. J Gerontol A Biol Sci Med Sci 2020; 76:1333-1339. [PMID: 32542343 DOI: 10.1093/gerona/glaa147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In randomized clinical trials, compared to Internal Medicine, admission to Geriatrics improved clinical outcomes of frail older patients accessing the Emergency Department (ED). Whether this advantage is maintained also in the "real world" is uncertain. We compared long-term survival of patients admitted to Geriatrics or Internal Medicine wards after stratification for background risk and across a variety of discharge diagnoses. METHOD Data were derived from the "Silver Code National Project," an observational study of 180,079 unselected 75+ years old persons, admitted via the ED to Internal Medicine (n = 169,717, 94.2%) or Geriatrics (n = 10,362) wards in Italy. The Dynamic Silver Code (DSC), based on administrative data, was applied to balance for background risk between participants admitted to Geriatrics or Internal Medicine. RESULTS One-year mortality was 33.7%, lower in participants discharged from Geriatrics (32.1%) than from Internal Medicine (33.8%; p < .001), and increased progressively across four DSC risk classes (p < .001). Admission to Geriatrics was associated with survival advantage in DSC class II to IV participants, with HR (95% CI) of 0.88 (0.83-0.94), 0.86 (0.80-0.92), and 0.92 (0.86-0.97), respectively. Cerebrovascular diseases, cognitive disorders, and heart failure were the discharge diagnoses with the widest survival benefit from admission to Geriatrics, which was mostly observed in DSC class III. CONCLUSIONS Admission to Geriatrics may provide long-term survival benefit in subjects who, based on the DSC, may be considered at an intermediate risk. Specific clinical conditions should be considered in the ED to improve selection of patients to be targeted for Geriatrics admission.
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Affiliation(s)
- Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Italy.,Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Carreras
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Antonella Giordano
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | | | - Stefano Buda
- Clicon - Health, Economics & Outcome Research, Ravenna, Italy
| | | | | | - Niccolò Marchionni
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Italy.,Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Balzi
- Department of Epidemiology, Azienda USL Toscana Centro, Florence, Italy
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